Provider Demographics
NPI:1306845318
Name:FARRELL, LYNDA TOMALONIS (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:TOMALONIS
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0248
Mailing Address - Country:US
Mailing Address - Phone:434-392-3187
Mailing Address - Fax:434-392-5789
Practice Address - Street 1:BUSH RIVER RT. 460
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901
Practice Address - Country:US
Practice Address - Phone:434-392-3187
Practice Address - Fax:434-392-5789
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040019631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA800001017Medicare PIN